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HomeMy WebLinkAboutMiscellaneous - 39 SALEM STREET 4/30/2018 (2) - - _ J i _ _ _-_ - _ _ --- \. 1 736 _ -APPLICATION FOR SEWER SERVICE CONNECTION / North Andover, Mass. 3'.n . a `{ iG'. Application by the'undersigned is Hereby made to connect with'the town sewer main in !/l/� Street, subject to the rules and regulations of the`Division'of'Public Work's. / The premises are known as No. t4 Street or subdivision lot no. ` Owner f Address Contractor Address. R pplicanY's Sig ature` lit t7 tf3Llt F{i'It #iC3 w`•; ;;,Ol`d qtr 19t'3!@a '.a53`,Jri dTfz ini �JvIii t S s! '/�t=.t.t V - ;- if it . jd gilt � � oq vvSAr o t ld ')tit 0, tCI Vrl a 2i��lb B fi� , ' It 'ht � �keltP)C� t .P 141 `_ „- �5t t}`_> ,t.3yr>,1 '}(1 F4.✓ ,=,'A'i'°[f. (' i'; t PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. i Division of Public Works By j Inspected by i Date See back for rules and regulations ii t' I, I' RgAO UOTk NoRTi l RCQI?tN6 IAAI;4. - .'SG.t�,6.t�. y j Ir �/ C Ail r o T. 2 t- b ASA- 6A ALTA Q 44M , ,...�....+• F 1 ....� �•�..—.�. �a �'��+i�-..rte.�� � .. 5 � -O�- 3G1 rC __ LUT ' �• +'tl;�,;�' ♦wr�S� Jw 117 Ttl1iS��. 70 d'I1+i , ✓A 'ifi -l"7t ~ ,�7..�•b ' , -1f t - -• -D!'V ' iii �t { ,r ,� ,�� .?. .. � r •jt.K �D< '♦ '.-; 1�,E t�^�� •`� Y f t S} 1.�(,'{ � r r .f BSt "�' 1 Q FEND � �11• {, L •, , 1A' 'h f:�' i i ._ Yy "r4����°xDt��.lyt ,;- � t �_At• i r •F . 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H&C PERC+:A ANTE 0 PERC TEST F� Ay :i F Commonwealth of Massachusetts -- = '= + Executive Office of Environmental Affairs AUG Department of 71997 • Environmental Protection William F.Weld j' Governor TrudyCoxe %.W.ry,EDEA David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A UV LI C A PbV CERTIFICATION /' , A f e Property Address: 3 9 5dPt '��r S r Address of Owner: Date of Inspection: -7— 9 7 (If different) Name of Inspector: �Lj;-v Company Name, Address and Telephone Number: 41 4ZA1L(—&AV CERTIFICATION STATEMENT f J� Q 0 M I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Ins ctor shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing it* inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. r INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B( SYSTEM CONDITIONALLY PASSES: One or more system components need to be re/p'l'aced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 ice,Printed on Recycled Paper ,,. .. ._._.,., ..... ......_.. ...., .-....ti....,-w.:.Y-a<-::.�wL.�'kr .My'..TFc......'nrs^." rw,..'Y" � n T . .. ... t.. nI"�• - r' • ( SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: 7 31 - 97 ; Date of Inspection: koV6--1Ch kUIJ B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): f broken pipe(s)are replaced obstruction is removed distribution box is levelled;or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass ax inspection if(with approval of the Board of Health): broken pipe(s)are replaced 'g *obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: NA Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. r 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND.SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The=sy'stem=has a sepfic=tankand s�srT`ab`sorption'system-and`iswithin a Zbn I of a"public kateF supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system fas a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. r, x D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded'or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ! PART A t CERTIFICATION (continued) Property Address: Owner: L..( C lL0 Date of Inspection: D]SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ liquid depth in cesspool is less than 6" below invert or available volume is,less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).. Number of times Any P , r ;s p � onion of the Soil Absorption Sy stem, cesspool or privy is below the high groundwater elevation. +rx Any portion of a c spool or privy is within 100 feet ofa surface water supply or tributary to a surface'water supply. _ Any portion of a cesspool or privy is within a Zone I of.a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100•feet;but•greater•than 50 feet from a private water supply well with no i acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and.nitrate nitrogen. E]LARGE SYSTEM FAILS: i The following criteria apply to large systems in addition to the criteria above: The design floe of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200.feet of a_t�ributary to a surface drinking water supply ` - _ - ihe=system is located- niasnrtrogerrasensmve area(I'nterrm WellRi ll-Proitcfion Area"(IWPA)',or a mapped Zone II of'a public water,supply well) t The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. s .k f r 1 r - (revised 8/15/95) 3 °. . 4 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM x PART B s CHECKLIST 't 3 r Property Address: 3 I Owner: Date of Inspection: /V_(/J U C AKUV 7- Check if the following have been done: a ��imping ' T �4 { ` ^ P.?information wasregges of the owner, occu a t, and Board of Health:; ,s �None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ' As built plans have been obtained and examined. Note if they are not available with N/A. � TT e facility or dwelling was inspected for signs of sewage back-up. he system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. _All system components, excluding the Soil Absorption System, have been located on the site. t ;The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or ,tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or /approximated by non-intrusive methods. V_/The facility o..ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. • yy t r W yf 4 Y (revised 8/15/95) 4 �..__,. .�.»�-.-... ._.�,.w1 tiw..l�.'y�-^_'Y''v^r'Y�..1 •„y. ,.. r..+-,. — .: ..., :.o ,, •a,..:.fr:.A"'_„^.^�'.q•y.•.11.. .vim r .M' hw`f.� - . -•..�.y,:.�,.n y+:- •'"1... - ... ' I ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:- Owner: LL Date of Inspection: k oU C SEPTIC TANK:4QS (locate on site plan) � t Depth below grade:L Material of construction: Leoncrete metal .FRP—other(explain) tDimensians: 0 V = J f, Sludge depth: fir, y a r .rte !f k Distance from top of sludge to bottom of outl� t tee or baffler Scum thicknessr- -1,`r rr Distance from top of scum to top of outlet tee or baffle: L Distance from.bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage, etc.) 4344 rr-Lr /Z.. a,(, b C'C_X4 01 7/10 �. T`�-�-t i2 .. �C.lc• L.•.rte'n i a_ :.s' GREASE TRAP:_ J 1 (locate on site plan) (/ 4 y I Depth below grade: ,x Material of construction: _concrete _metal FRP _other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: �, a Distance from bottom of scum t- bottom of outlet tee or battle: Comments.: � t. # w « - - (recommendation-for Pumping<condition oftinlet an Utlet tees•orrbaffles;depth of ltqurd=level do relatiomtoioutlet invert, structural integrrtyy evidence of leakage, etc.) t .1 �f t (revised 8/15/95) 6 k f . ...� `•'•1^ lrr�l•r'W'Y.r.....[.,+a �� .Y.. ... .. •..,.M �wlT.s.ir`h. �... .�.T i�w... .-,. .�, e'._ .• .:. •..�v.r. n'ww. ..ti +. 4. , f7 • Y x SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C � SYSTEM INFORMATION (continued) k Property Address: /'J �le psi J � /4, 4 ��0 U ✓� Ower �CU VL,(.4 C-412 6 0 Date of. Inspection: � 9 SOIL ABSORPTION SYSTEM (SAS):�/ P (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) .. If not determined to be present, explain: T i aN i. ��. ! b R d e g A. leaching pits, number:_ s• leaching chambers, number_ leaching galleries, number. " / ' IeachirZg,trenches, number,le";'gh: `r� �(�PUe!et leaching fields, number, dim ns: * �z overflow,cesspo91,6number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) /c, A4 .0 S'0 / L.- ! t + CESSPOOLS: (locate on site Ian) 1 { Number and configuration: Depth-top of liquid to inlet invert: ,f Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Y .^•"'V t.a„rfia.t .,-}"y P '). e... ;. d, j :t S� T; r u •..t. 1 * y r Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (' ' (locate on siteP lan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 Or +IG SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 5 SYSTEM INFORMATION (continued);;} Property Address: S�1P4o j o4,A.1 Owner: I Date of Inspection: (�v( f C ( ret 4 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' w t i , r" �-� 4 „ • r. ( f~ t.y' r+r•j- :}.� ., y.. ( ,�S'fir° f s. , "r'i3 v' ° '(' + A DEPTH TO GROUNDWATER f Depth to groundwater: t feet method of determination or approximation: �� 17.Gw,�� k( ,�CS FSG ,t U/)4 rD HTr w{ tits YI}t.u•swf' 17 YL�I (revised 8/15/95) 9 i Town of North Andover °�NORTH t��ao rys Office of the Health Department Community Development and Services Division 27 Charles Street •�u�-�- gO��reo North Andover, Massachusetts 01845 9SS"CHU Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 May 15, 2001 Resident 39 Salem Street No. Andover, MA 01845 Re: Sewer Tie-in Dear Resident: The Health Department has been supplied with a list of all residences, currently on septic, which have access to the municipal sewer system. Your property was listed as having access as of November 2000 due to the completion of the new sewer in your area. This office was notified that you were sent information from the Department of Public Works informing you of your status and the tie-in regulation. As previously published at a Public Hearing on March 17, 1994, the Board of Health has adopted regulations concerning the required sewer tie-in. The following timetable concerning your property status was adopted: 4.1 All establishments that currently do not have municipal sewer available to them must connect to the sewer as soon as it becomes available, with a maximum time limit of six months. The purpose of these regulations is to safeguard North Andover's drinking water, surface waters, groundwater and surrounding environment. Sanitary sewer is believed to be the most effective form of wastewater treatment. A copy of the entire regulation can be obtained at our office. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Any questions concerning this regulation should be directed to the Board of Health at (978) 688-9540. Additional inquiries regarding the physical tie-in and permitting process should be directed to the Department of Public Works at (978) 685-0950. Please be advised this Board intends to persevere in this regulation. Yours truly, Gayton Osgood, Chairman If<21 Francis P. MacMillan, M.D.,Member John S. Riiza, .M.D., ber SF/sc TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845-2909 J. WILLIAM HMURCIAK, DIRECTOR, P.E. Timothy J. Willett NORrN Telephone (978) 685-0950 Staff Engineer 3=o'���.n�6'��°0� Fax(978) 688-9573 F A ��SSACHUS�� November 1, 2000 TO RESIDENTS OF SALEM STREET: Please be advised that the recently installed sewer main on Salem Street haspassed all requireduired testing and inspections. Consequently, it is now ready for public use. This affects the following houses on Salem Street: #39, #40, #49, #58, #59, #69, #70, #79, #99, and#120. You may now begin the process of connecting to the sewer. A sewer connection permit must be taken out from this office. The fee for the permit is.$1,000.00. You must hire your own contractor to make the connection. A list of contractors is available at this office. Contractors not on the list may also be hired. The permit requires"sign-offs" from the Health Agent and Conservation Agent at 27 Charles Street. Once the permit has been paid, and has been signed by the Conservation and Health Agents, your contractor may proceed to connect your house to the sewer line. The Board of Health has a regulation in place stating that all homes that have access to town sewerage must connect within six months after a line becomes ready for connections. CC: Sandra Starr Susan Ford